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Creating ConnectionsA Comparison of Two Treatment Models Addressing Parent-Child Relationships
Dorothy Denny, MSW, LCSW
Welcome!
• Presentation overview:• Description of PCIT and CPP• Comparison of the two models• Demonstrations• Guidelines for selecting treatment modality• Discussion and questions
Parent Child Interaction Therapy (PCIT)
• Developed for families with young children experiencing behavioral and emotional problems• Therapists coach parents during interactions with
their children to teach new parenting skills• Skills are designed to enhance parent-child bond,
reduce child negative behaviors, and increase parenting efficacy
Child-Parent Psychotherapy
• Developed for young children exposed to trauma, especially domestic violence• Typically sessions conducted with child and
parent or significant caregiver together• Therapist aims to engage with parent/child dyad
to create safety, promote attunement and change negative interactional patterns• Parent and child create joint trauma narrative
that identifies and addresses trauma triggers
Theoretical Underpinnings
PCIT• Behavior theory• Attachment theory• Social learning theory
CPP• Integrates psycho-
analysis and attachment theory• Includes
developmental theory, cognitive-behavioral and social learning approaches
Target population
PCIT
• Ages 2.5 to 6• Has been adapted for
older kids (up to age 12)• Presenting concerns• Child disruptive
behavior• Parent coercive
discipline
CPP• Ages Birth to 5• Presenting concerns• Exposure to domestic
violence• Separation anxiety• Emotional dysregulation• Parental depression• Chronic stress• Bereavement• Attachment “fit”
Treatment Length and Structure
PCIT• Clinic-based (has been
adapted for home-based treatment)• Average 12-20 weekly
sessions• Highly structured• Phase-based treatment:• Child Directed Interaction• Parent Directed Interaction
CPP• Clinic or home based• Average: 50 weekly
sessions• Flexible• Non linear• 3 general treatment
phases:• Relationship /process building• Targeting problem areas• Recapitulation/termination
Client Constellation
PCIT• Parent and child• Parents can be foster
or kinship caregivers• Parents must have
daily access to child for home practice
CPP• Parent/caregiver and
child• Parents can be foster
or kinship caregivers• Can be implemented
during supervised visitation for children in child welfare system
Therapist Role/ Alignment
PCIT• Therapist = Coach
• Therapist is aligned with the parent
CPP• Therapist = Facilitator
• Observer/Interpreter
• Therapist is aligned with the child-parent dyad
Necessary Resources for Implementation
PCIT
• AV equipment• Space• Toys
CPP• Toys to evoke child’s
memory or emotion about a traumatic event
Training/Supervision Requirements
PCIT
• 40 hours of face-to-face training with a PCIT trainer• 6 months phone
consultation with trainer while seeing cases• No specialized
supervision required
CPP• Varies according to
setting and need• In-person training or
learning collaborative models• Consultation and
reflective supervision
Assessment ProcessPCIT
• Clinical interview• ECBI • PSI• DPICS observation• Other standardized
measures as appropriate
CPP• Observations across
conditions• Developmental history• Caregiver perspective on
child and family situation• Caregiver history and
psychological functioning• Cultural “niche”• Standardized
assessment measures
Evidence Base
PCIT
• Several RCTs showing long-term maintenance of treatment gains• CEBC rating of 1
(“well-supported by research evidence”) on scale 1-5
CPP• 3 RCTs with trauma-
exposed young children • CEBC rating of 2
(“supported by research evidence”) on scale 1-5
AdaptationsPCIT
• Families and children with prenatal exposure to alcohol and other drugs• Group treatment• Children 8-to-12 years of
age• Children with medical
conditions.• Physically abusive
families• Native American families
CPP• Latino families• African American families• Native American families• Asian families• Recent immigrants• Anxiously attached dyads• Depressed mothers• Chronically stressed
families
Possible Barriers to TreatmentPCIT
• Lack of home practice opportunities (e.g., when parents do not live w/ child)• Inability to attend
weekly sessions makes skill acquisition much more difficult• Cognitive impairment
of caregiver• Lack of AV equipment
CPP• Parents unwilling to
engage in emotionally laden and trauma focused work• Cognitive impairment
of caregiver• Ongoing domestic
violence or otherwise unsafe environment• Lack of clinician access
to reflective supervision
Therapist Anxieties PCIT
• Too manualized• Degree of therapist
direction• Lack of comfort with
time out procedures
CPP• Not manualized
enough• Alignment issues • Reluctance to process
traumatic material• Less comfort or
familiarity with psychodynamic theory • Fewer family therapy
skills • Reflective supervision
Essential Elements-PCIT
• Coding• Coaching• Home practice
DPICS CODING SHEET FOR PRIDE SKILLS (CDI CODING SHEET)
Date:______________ Session:________________
Child’s Name:____________________ Caregiver Name:____________________
Child Directed Interaction
Positive Tally Total Mastery
Talk (TA)
Behavior Description (BD)
Reflection (RF)
Labeled Praise (LP)
Unlabeled Praise (UP)
Avoid Tally Total Mastery
Question (Q)
Commands (DC + IC)
Negative Talk (NTA)
Positive Check One
Imitate Satisfactory Needs Practice
Use Enthusiasm Satisfactory Needs Practice
Ignore Disruptive Behavior Satisfactory Needs Practice Not Applicable
Other (specify)
Essential Elements-CPP
• Developmental guidance• Attunement• Curiosity and empathy• Ports of Entry•Moments of meaning• Reflective supervision
Domains of Intervention- PCIT
• Parent-child “special playtime” at home• Weekly coaching sessions of parent utilizing skills
in play situations • Parent’s discipline of child• Parent’s communication with child
Domains of Intervention-CPP
• Play• Biological disruptions• Child’s behaviors• Child’s aggression• Physical punishment• Derogation, threats, criticism• Relationship with absent parent/perpetrator• Ghosts/Angels in the nursery
Treatment Goals-PCIT
• Improve parent-child attachment relationship • Increase parent’s warmth and responsivity to child• Reduce frustration/anger on part of both parent
and child• Help parent and child view one another more
positively• Increase child’s social skills, attention, and self-
esteem
Treatment Goals-PCIT
•Decrease child’s disruptive behaviors• Increase parent’s use of effective discipline skills• Increase parent’s predictability, consistency, and follow through• Enable parent to generalize discipline skills to other settings
How Treatment Goals are Achieved-PCIT
• PRIDE skills• Daily parent-child “Special Time” at home• Command training – giving good instructions• Coaching parent to implement detailed discipline
procedure• Planned responses to• Refusal to stayy in time-out• Impulsive or dangerous behaviors• Behavior disruptions in public settings
• Gradual generalization from clinic minding exercixes to “real life” discipline
Treatment Goals - CPP
• Return to normal development• Respond realistically to threat• Regulate levels of emotional arousal• Re-establish trust in body sensations• Restore relational reciprocity• Normalize traumatic response• Differentiate remembering from reliving• Place traumatic experience into perspective
How Treatment Goals are Achieved - CPP
• Using child’s play and language to explore themes• Conveying developmental guidance• Modeling protection• Interpreting feelings and actions• Providing emotional support and empathic
communication• Offering material help
Determining best treatment option: PCIT or CPP??Questions to Consider:• Age of child• Child’s relationship with caregiver• CPS or Court priorities• Trauma history of child• Trauma history of caregiver• Symptom presentation• Safety concerns• What else??
Questions & Answers
Bibliography• Bodiford McNeil, C, & Hembree-Kigin, T. L. (2010). Parent-child
interaction therapy 2nd ed.) New York: Springer. • Lieberman, A. (2004). Traumatic stress and quality of
attachment: Reality and internalization in disorders of infant health. Infant Mental Health Journal, 25(4), 336-351.
• Lieberman, A., & Van Horn, P. (2005). Don't hit my mommy: A manual for child-parent psychotherapy with young witnesses of family violence. ZERO TO THREE Press.
• And special thanks to our CASGSL staff and children for participating in the videos.
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